AB0547 EVALUATION OF THE CLINICAL OUTCOME, PRESCRIPTION PATTERNS AND COST OF TREATMENT IN PATIENTS WITH LUPUS NEPHRITIS IN A TERTIARY CARE HOSPITAL
Authors: M. Eldhose K, S. Kamat, P. Marathe, M. Nadkar, A. Sonawale, N. K. E
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Lupus nephritis (LN), a rare but severe renal manifestation of Systemic Lupus Erythematosus (SLE), has one of the most unsatisfactory renal disease outcomes, posing a great challenge for treatment. The clinical outcomes with various treatment regimens in LN have been studied globally in many randomized controlled trials (RCT). However, there is a paucity of data on clinical outcomes with various treatment regimens in Indian LN patients despite these regimens being extensively used in clinical practice. Only a few studies have analyzed prescription patterns in LN but none of these studies were conducted in India. Also, there is a substantial economic burden associated with SLE and LN in terms of healthcare resource utilization. The economic burden on Indian LN patients is not known and the cost of illness studies is not reported in the literature. <h3>Objectives</h3> The objectives of the study were to assess the clinical outcome in terms of disease activity in patients with LN at the end of induction therapy and at the end of maintenance therapy of 12 months, and to evaluate prescription patterns and cost of the treatment in patients with LN. <h3>Methods</h3> A prospective, observational, single-center study was conducted in the rheumatology department of a tertiary care hospital. The study was conducted in two parts. Part- 1 was cross-sectional, where the clinical outcome in LN patients at the end of maintenance therapy of 12 months was assessed (based on American College of Rheumatology- Renal Response Criteria (ACR – RRC)), while part- 2 was a longitudinal study where clinical outcome at the end of induction therapy or at the end of 6 months was assessed along with prescription patterns and cost of treatment. <h3>Results</h3> A total of 64 LN patients with 41 patients in Part-1 (cross-sectional) and 23 patients in Part-2 (longitudinal) satisfying the eligibility criteria were included in the final analysis. In the cross-sectional part of the study, all 41 patients showed a response to treatment at the end of maintenance therapy for 12 months (Table 1). In the longitudinal part of the study, most of the LN patients (65.21%) showed a partial response at the end of induction therapy. The prescription pattern analysis showed that 66 (57.40%) prescriptions out of a total of 115 prescriptions were complete with the average number of drugs prescribed per encounter being 10.77 ± 1.85 (Mean ± Standard Deviation). The most prescribed immunosuppressant was MMF (59%). The direct costs incurred by the patient {Rs.24001.01 (11204.36– 29110.02), (Median (interquartile range)} were much higher as compared to the indirect costs {Rs. 3000 (2000-3150), (Median (interquartile range)} due to the higher cost borne by the patient for drug therapy {Rs.16429.49 (5260.07 – 22585.04), (Median (interquartile range)}. <h3>Conclusion</h3> The clinical outcome at the end of 12 months of maintenance therapy was found to be satisfactory, with all the LN patients being responders to treatment. The MMF regimen was the preferred treatment regimen over the equally efficacious cyclophosphamide-based regimens due to the ease of administration and non-requirement of hospitalization during the period of the COVID pandemic. The high cost of MMF increased the direct cost borne by the patient due to its unavailability in the hospital pharmacy. Hence there is a need to review the hospital pharmacy stock at regular intervals and streamline the procurement system for drugs during public health emergencies such as the pandemic. <h3>Reference</h3> [1]Morales E, Galindo M, Trujillo H, Praga M. Update on Lupus Nephritis: Looking for a New Vision. Nephron. 2021;145(1):1-3. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.